ABSTRACT
BACKGROUND: The aim of the study was to quantify the changes in cardiopulmonary function after minimally invasive video-assisted mitral valve repair for organic mitral regurgitation (MR) in asymptomatic or minimally symptomatic patients. METHODS: Twenty-six patients (age 54 +/- 11 years) with severe organic MR (regurgitant volume of 94 +/- 37 mL, effective regurgitant orifice [ERO] of 0.73 +/- 0.35 cm2) and mild or no symptoms (New York Heart Association class 1.2 +/- 0.4) underwent exercise echocardiography and cardiopulmonary exercise testing 1 week before and 4 months after uncomplicated video-assisted mitral valve repair. RESULTS: During exercise, left ventricular ejection fraction increased from 68% +/- 7% to 74% +/- 6% (P < .0001), but ERO did not change significantly. Four months after video-assisted mitral valve repair, a significant improvement was observed in peak oxygen uptake (VO2max from 23 +/- 6 to 25 +/- 7 mL x kg(-1) x min(-1), P < .001), peak oxygen pulse (11 +/- 3 to 12 +/- 4 mL per beat, P < .005) as well as in maximal workload (from 143 +/- 49 to 159 +/- 55 W, P < .0001). When only patients without any symptoms (New York Heart Association class I, n = 20) were considered, these changes were even more pronounced (VO2max from 24 +/- 7 to 27 +/- 7 mL x kg(-1) x min(-1), P < .001). Post-operative changes in VO2max correlated with preoperative exercise-induced contractile reserve (r = 0.72, P < .0001), preoperative ERO (r = 0.49, P < .05), and preoperative ejection fraction at rest (r = 0.42, P < .05). CONCLUSION: In patients with severe organic MR but mild or no symptoms, cardiopulmonary performance improves after successful minimally invasive video-assisted mitral valve repair. Improvement is directly related to preoperative left ventricular function and contractile reserve.
Subject(s)
Exercise Tolerance , Mitral Valve Insufficiency/physiopathology , Mitral Valve Insufficiency/surgery , Adult , Aged , Echocardiography, Doppler , Echocardiography, Stress , Exercise Test , Female , Heart Function Tests , Humans , Male , Middle Aged , Mitral Valve Insufficiency/diagnostic imaging , Postoperative Period , Quality of Life , Thoracic Surgery, Video-Assisted , Treatment OutcomeABSTRACT
AIMS: Exercise-induced mitral regurgitation (MR) bears a poor prognosis in patients with congestive heart failure (CHF). Cardiac resynchronization therapy (CRT) is associated with improved clinical outcome but its effects on exercise-induced MR remain undetermined. We investigated serial changes in functional MR in relation to left ventricular (LV) remodelling and cardiopulmonary performance after CRT. METHODS AND RESULTS: Twenty-eight patients with CHF (LV ejection fraction 25 +/- 7%), broad QRS complex (171 +/- 27 ms), and at least mild MR [effective regurgitant orifice (ERO) 0.25 +/- 0.12 cm2] were studied with quantitative exercise echocardiography and cardiopulmonary exercise testing prior, within 1 week, and 3 months after CRT. Early after CRT, a decrease in LV dyssynchrony (from 54 +/- 21 to 19 +/- 7 ms, P < 0.001) and in MR at rest (ERO from 0.25 +/- 0.12 to 0.20 +/- 0.10 cm2, P = 0.047) was observed. However, no change in exercise-induced increase in MR was observed (ERO from 0.34 +/- 0.12 to 0.31 +/- 0.16 cm2, NS). Three months after CRT, a decrease in the mitral valve tenting area (from 3.3 +/- 1.2 to 2.0 +/- 0.6 cm2, P < 0.001) and an increase in LV sphericity index (from 1.5 +/- 0.3 to 1.8 +/- 0.5, P < 0.001) were paralleled by an attenuation of exercise-induced MR (ERO 0.19 +/- 0.06 cm(2), P = 0.001 vs. prior CRT). This was associated with an increase in LV ejection fraction (from 25 +/- 7 to 35 +/- 9%, P < 0.001), peak oxygen uptake (from 11.7 +/- 2.4 to 13.7 +/- 3.8 mL/kg/min, P = 0.001), and a decrease in Nt-pro-BNP (from 2777 +/- 1681 to 1963 +/- 1361 pg/mL, P = 0.067). CONCLUSION: CRT is associated with acute decrease in resting MR but does not immediately attenuate exercise-induced MR. In contrast, only late, CRT-induced reversed LV remodelling and reduced mitral apparatus deformation are associated with a reduction in both resting and exercise-induced MR and with an improvement in cardiopulmonary performance.
Subject(s)
Cardiac Pacing, Artificial/methods , Exercise/physiology , Heart Failure/therapy , Mitral Valve Insufficiency/prevention & control , Ventricular Dysfunction, Left/therapy , Aged , Echocardiography, Doppler , Exercise Test/methods , Female , Heart Failure/physiopathology , Heart Function Tests/methods , Humans , Male , Mitral Valve Insufficiency/etiology , Mitral Valve Insufficiency/physiopathology , Oxygen Consumption/physiology , Pacemaker, Artificial , Ventricular Dysfunction, Left/physiopathology , Ventricular Remodeling/physiologyABSTRACT
We report the case of a 37-year-old woman with a right ventricular mass (detected by echocardiography and PET-CT) associated with cervical cancer. After radiation therapy there was no more evidence for a mass in the right ventricle. We wish to stress that, although the outcome for cervical cancer with cardiac metastases is still very poor, prognosis has improved with advanced imaging technology and radiation therapy.
